Advancements in Detection and Management of Ductal Carcinoma in Situ

Ductal carcinoma in situ (DCIS) is a noninvasive breast cancer characterized by neoplastic epithelial cells confined to the ductal system by the basement membrane without invasion of adjacent tissue. Its progression to invasive carcinoma is not understood fully, and currently, DCIS is considered a nonobligatory precursor of invasive breast cancer. However, DCIS is challenging because it includes a heterogeneous group of lesions with varied histologic, immunohistochemical, genetic, radiologic, and clinical characteristics. This heterogeneity is reflected in its natural progression, with some lesions remaining indolent, whereas others may develop into invasive ductal carcinoma. As DCIS detection rates rise due to mammographic screening, concerns about overdiagnosis and overtreatment have emerged, which has lead to a greater focus on understanding the biologic characteristics of DCIS. Radiologists need to understand the various imaging techniques used to evaluate DCIS. These include mammography, contrast-enhanced mammography, tomosynthesis, US, and MRI. By familiarizing themselves with each modality's various strengths and limitations, radiologists can effectively assess DCIS and develop the appropriate treatment plan. Although current guidelines advise treating all cases of DCIS with surgery, radiation therapy, and hormonal therapy, ongoing trials are investigating the safety of active surveillance for women with low-risk DCIS. There is interest in improving the risk stratification of DCIS lesions, and new advanced tools, such as radiomics, artificial intelligence, and other emerging techniques, are showing positive initial results and have the potential to become valuable solutions in the future. However, further studies and development still are needed before they can be widely adopted in clinical practice. Published under a CC BY 4.0 license See the invited commentary by Chikarmane in this issue.